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Monday
Aug022010

Monday Open Thread

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By Jill—Unnecesarean

This week’s open thread is hosted by Mr. T becuase he was the first person to come to mind. Feel free to analyze why I dream of Mr. T or say the first thing that pops into your head. Well structured, coherent arguments or links to articles also welcome.  

 

 

 

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Reader Comments (37)

Hi EmH, I was trying to link to rixarixa.blogspot.com - her dissertation is linked in her About Me on the upper right.

Another Rachel, interesting question. At first I was thinking, well, the tragic fits better into the OB worldview (birth is dangerous) but now I'm not sure. If it's like this:
OBs: birth is dangerous, we will control it
MWs: birth is safe, but uncontrollable
does the tragic fit in better with one or the other? Who has more cognitive dissonance to deal with when someone dies or is badly injured?

August 2, 2010 | Unregistered CommenterJMT

My four-year-old has been wandering around telling people they're "actin like a FOOL!" and that has felt very Mr. T.

My wish would include some actual good research on gestation length, and whether 42 weeks is really the outside safe limit.

Well, and much more research on birth in general, better diagnostic tools, less guesswork and more knowledge.

August 2, 2010 | Registered CommenterEmjaybee

I am just thinking about a friend back in my home town who is pregnant with her second child. She seems so excited and I know she was very interested in my VBAC story. She had a C/S with her first because of low amniotic fluid at ~ 34 weeks. This pregnancy seems to be going much better for her, so I am fairly sure it will be much easier for her. Every time I tell her about my VBAC she seems enthusiastic about "trying" but also seems to think that she may not be able to do it. I am trying to be supportive of her no matter what decision she makes but there is this part of me that wants to help her see why my VBAC was so important in my life, and how empowering it was. I just dont think that is going to happen, and I hear her saying alot of things about her Dr that make me worry that she will end up being just another repeat C/S. I guess I am just realizing how hard it is to not try to influence people's decisions about birth when I am so much more passionate about it. I dont want to be the pushy person who shoves my ideals in everyone's face, so I guess for now I will just try to point her to the info I found helpful, and hope that she gets the picture on her own before it's too late.

Also, wondering what everyone feels is a good time to start weening my daughter from breastfeeding? I get different answers everywhere I go, her pediatrician seems to think I can do it anytime now, but I am wondering if I should go the whole first year or maybe just 6-9 months? Anyone have info on health benefits/timeframes for breastfeeding? I love the bond I feel with her and I know I will miss that.. Advice is greatly appreciated :)

August 2, 2010 | Unregistered CommenterLilRedMommy

Thinking about miscarriages here. My sister and three good friends have lost babies, all within the last few months, with a range of a few weeks to 24 weeks gestation. It just happens so often. Way more than I used to think it did.

It's happened to me three times that I know of. Twice when I was on the pill. Positive pregnancy test, though the line would be a little pale, then nothing only a day or two later. Damn pills. Tried to talk to my Gyn, but after I had to explain to her and to her nurse how birth control pills work...well, with no better options, I just went off the pill. No more losing babies because of a too-thin buildup in the wall of my uterus. Yes, I know it's not supposed to be very common. But it happened to me. And there are no good figures that I can find that show how common that effect of the pill is. I happened to catch it because I can tell when I ovulate, and because I get full-on pregnancy symptoms IMMEDIATELY. I'm talking dill pickles and strawberry ice cream five minutes after fertilization. (I can never decide if that's a blessing or a curse.)

We had no trouble conceiving our now 4 year-old boy, and DH and I have been very careful with condoms, so I'm not anxious about my fertility or anything. But I can't help but think about how miscarriages are treated. My sister was given a handful of misopropyl/cytotec to take at home after seeing her little one on screen at about 8 weeks along, with no heartbeat. The pain and nausea and cramping was so bad it scared her ER nurse husband silly. He told me he was "this close to calling an ambulance." Her doctor hadn't given her anything for the pain, never warned her what it would be like, just told her to be sure to collect a bit of what she had "passed" for testing. And now she's all worried that there's something wrong with her. Just found out she's had two miscarriages before, so I guess that's not being too alarmist. (She does have a daughter already, though, and I'm hoping that treating some underlying health conditions will help her reproductive system do its thing.)

Anyway. It's just been on my mind a lot.

August 2, 2010 | Unregistered CommenterMelissa

@ LilRedMommy:

I'm sure others will post on this too, but just wanted to encourage you to continue to breastfeed. How's it going for you and your daughter? Keep doing what you're doing. Breast milk will continue to change with her needs (different nutritional content, specific antibodies, etc.), and that's something no other food can duplicate, even when she begins to be ready for solids or even cow's milk (there's no hurry with either there, by the way, and introducing new foods before her system is ready can have negative effects). Anybody who tries to hurry you along and tell you that you should quit nursing doesn't know what they're talking about.

If you want good info, look at what the World Health Organization recommends, not what Nestle or Carnation (formula companies) are trying to sell--and by the way, that may include your pediatrician, too. (Most peds know hardly anything about nursing. Mine, for instance, kept trying to get me to stop nursing if DS was sick...according to him, he should only have pedialyte. How crazy is that? No thanks, I'm not about to stop giving him the perfect and most easily digestible food and hydration, nicely laced with antibodies against the bug he's fighting...)
Take a look at http://www.who.int/topics/breastfeeding/en/ for a good start. If you follow their links, you'll notice that they talk about "complementing" your baby's breastmilk diet (beginning at about 6 months or so, no hurry!) rather than "supplementing." No other food compares to a mother's milk. Their recommendations are: "Exclusive breastfeeding is recommended up to 6 months of age, with continued breastfeeding along with appropriate complementary foods up to two years of age or beyond." So in other words, what's best for baby's health is to continue to breastfeed until sometime in to that toddler stage, or even longer if you (and baby) want to.

Personally, we nursed till my son was 13 months. By then he could eat steak. Seriously...he ate steaks from my cousin's first deer at just past 12 months. That boy was cutting molars when other kids were cutting eye teeth. At that point he was down to one short nursing session a day...it just kind of happened. I weaned him just in time to be abe to go on our annual camping trip with friends...no tots, just lots of staying up late and pretending to be college kids again. He didn't ever ask for the boob again...never gave any sign that he missed it or was sad. And I didn't feel hurried. He was a champion nurser, and I loved the cuddling time. Thank goodness he kept that desire for cuddling! It was time for us. I knew I wanted to nurse till he was at least a year, and everything else would be played by ear. Next time might be longer; we'll see.

The way I see it, you've got three things to consider.
1. The science on the health benefits for your baby. Every major study pretty much boils down to breastmilk = magic baby food. Minimum a year. Afterwards, up to you, though the kiddo still gets benefits from nursing long after that first year.
2. Your feelings on the subject. At some point you may need your body back to feel sane! Or conversely, you may LOVE every minute of nursing and by disappointed when eventually your little darling loses interest. This is something special that only you can give her. And that's pretty special to a momma's heart.
3. Your baby gets more than just nutrition and health perks out of the nursing relationship. Getting fed while mommy cuddles her, warm and safe and loved...well, it doesn't get better than that. Friends who've nursed into their child's 2nd or 3rd year report that nursing really helps calm an overwhelmed, freaked-out toddler. I've seen it in action. So your daughter may have opinions on the subject of how long you nurse!

Don't let anyone guilt you into making a decision you know isn't right for you (and your daughter), no matter what you decide.

August 2, 2010 | Unregistered CommenterMelissa

@ Emjaybee, I remember reading somewhere that 43 weeks is really when risks start to increase for stillbirth and post-maturity syndrome (and it's like, 1% risk increase AFTER 43 weeks and 44 weeks I think it's like 5% have post-maturity if I'm thinking right). Google harder. If I remember I'll come back and post links at some point on a Monday. heh.

The @ 41 weeks it's a GREAT idea to induce study is flawed (give me a break with names tonight, NAK), it was not well controlled.. 42 weeks is really not the upper limit for safe pregnancy.. 42 weeks is really just when most people would've statistically delivered. It's not when people will start imploding. Yes, with post-dates pregnancy (post-dates being defined as PAST 42 weeks) there are increased risks in some studies. But many studies did not control for whether or not the increased risks were because they were post-dates or were because of something CAUSING the post-dates, like a thyroid malfunctioning or a pre-existing malformation etc., (sort of like with breeches)- and when you control for things that -cause- the post-dates, many risks of being post-dates disappear until 43 weeks..

Also, you must take into consideration that women with different length cycles will have incorrect EDD's if they base their pregnancy on LMP vs. ovulation date. Unless of course they (collective they) are a believer that all women have 28 day cycles and a little wheel is more accurate than a woman charting based on symptoms, body temperature, secretions, etc. which I personally believe all women should do in order to really get to know themselves.. Anyway, incorrect EDD is a good reason for women to figure out when they ovulate if they can. This is a big reason for iatrogenic prematurity, by the way. LMP calculations are notoriously inaccurate. It goes the other way too. Many women are under the assumption they are 41 or 42 weeks, when they may actually be 39 or 40 and still have another 2 or 3 weeks before risk would begin to increase!!!

@ Jill You may not know why I'm saying this, but, I'm glad to hear you think I'm smart (even if I am slightly annoying) and that my son is adorable ;)

@ Lilredmommy. Hmmm.... 6 months of breastfeeding only?? Your pediatrician is operating on old information that frankly needs to be corrected. The best thing you can do is keep breastfeeding your child until at least the age of 2, given they are willing! It's really what is best for their health and development if it is at all possible to do so. I don't know why docs still think forcefully weaning at a half a year to a year is a good idea, considering all the medical evidence is to the contrary.

Just a few links.

http://www.kellymom.com/bf/bfextended/ebf-benefits.html
http://www.whale.to/a/extended_breastfeeding.html
http://www.motherandchildhealth.com/Prenatal/sarah/ext_breastfeeding.html

I have a 16 month old that is still happily nursing, so perhaps I am a tad biased, but I believe wholeheartedly that allowing him to continue nursing is what is best for his health and development.

August 2, 2010 | Unregistered CommenterFogedaboudid

@Mellisa
Thank you so much for that, there is definitely pressure for me to stop nursing in the near future, baby girl is less than 5 months old and I know I am not ready yet. I LOVE that cuddle time you are talking about, it is so nice to just get to snuggle up with her at the end of a long work day. Honestly, the main reasons I have been thinking about it are that I am having alot of difficulties pumping enough for her while I am at work. I've already had to start supplementing with formula, so she eats about 20% formula now. I have tried everything I can think of to increase my supply of milk, supplements, longer feedings, pumping between feedings (and lots of other stuff that was suggested to me) and none of it seems to make a difference-- scratch that, it makes a difference on one side. I have had a huge problem with the discrepency of milk production between my right and left sides. Left side does beautifully and produces a pretty good supply, and right side produces a measly 1-1.5 oz when pumping (and I notice my daughter loses interest in that side much quicker as well). Because of this I just cant seem to keep up with her demand. I love the actual breastfeeding part, but the pumping is driving me crazy, taking time out of my workday (which also takes money out of my pocket), and frustrating me because I feel so dissapointed when my right side produces so little. Add to that the fact that I am applying for a promotion in the next week, and I am worried they will think less of me because they know I have to take that extra time for pumping on my breaks, and I am just stressing out about the whole thing. I wish I could actually breastfeed her every day and have that bonding time that we both love so much, but unfortunately that is just not going to happen. If I could give her all those good nutrients and antibodies without having to pump I would be happy too, but that is also not going to happen :/ So I am just going to keep going as long as possible, and hope that I am able to make it to a year. I know how wonderful that would be, and I really appreciate the encouragement. It reminded me why this was so important to me in the first place. Thanks!
@Fogedaboudid
Thanks for the links, any help I can get is appreciated at this point. I am doing everything I know to make this happen, but I also know that after she is 1 year old I will no longer be given the extra time for pumping at work, so I will be forced to stop at that time. I know I will not be stopping soon, because I love the bonding time especially when I have been away from her for almost 12 hours on work days. It's tough when everyone just thinks I can stop anytime, because it means alot to me to be able to give to her like that. In some ways I guess I was feeling discouraged and started to believe all the things people were saying to me, it's nice to get the encouragement here. Thank you!

August 2, 2010 | Unregistered CommenterLilRedMommy

I am getting close to my due date and looking foward to a much better experience this time. My daughter was a "postdates" induction at 41 weeks. It was a "lovely" cytotec induction complete with fetal distress and the worst pain i have ever felt (and i have had multiple kidney stones and surgeries). 2 friends gave birth this last week at >42 weeks gestation. One was a successful hospital VBAC at 42+1 weeks and the other was a first time mom with a frank breech homebirth with a midwife (in Kentucky, where home midwifery is illegal) at 42+5 weeks. If they can do it, surely i can :-).


@LilRedMommy, For help pumping enough, try the forum at KellyMom: http://forum.kellymom.net/index.php They have great info/advice. A lot of times mothers overfeed baby while at work, you really only need 1 ounce/hour that you are gone. 1-1.5 ounces on one side is normal pumping output. How many times are you pumping each day? I am also still nursing my daughter at (almost) 16 months (and i am 38.5 weeks pregnant - i am lucky to still have milk, though). My goal is 2 years, but i may go longer. Also, you can stop pumping at 1 year and still nurse at home. I no longer pump at work and still nurse 2-3 times a day at home. When I am off work, i nurse more often and my body adjusts.

August 3, 2010 | Unregistered CommenterMaggie

LiLRedMommy.. how much milk do you leave her with? I assume it is about 12 ounces for the 12 hours you are gone? That could be a little tough to maintain, for anyone, since pumps are not that great vs. the baby. Babies are much better at extracting milk.

When you're with her, do nurse more often! She'll see you as high supply time and while you're at work, lower supply time. We also produce the most prolactin at night time - so your supply at night is probably quite a bit higher than during the day, anyway.. So nursing more at night WILL get her more breast milk than you probably think. Pump output is no indication of supply, anyway!

And about how much milk you are leaving... If it is a lot more than 10-15 ounces for 12 hours, I don't know if that's necessary.. Kellymom.com (one of the links I gave you) says that when apart from mom they only need a little less than 1 to 1.25 ounces per hour of separation (assuming they don't reverse cycle or reverse cycle some). It'll create a "low supply" time apart from mom and a "high supply time" with mom.

1.5 ounces is really good and normal pump output, actually. Normal pump output ranges .5-2 ounces COMBINED.. ;) Many women don't respond well to the pump... I could only ever get about 1/4 ounce out of each breast, my son is fine, and I've known women who could feed twins but couldn't pump squat! 1.5 ounces out of one breast is really great output.. not measly! Yeah, I know women who can pump 4-10 oz out of each breast, too, - but they have an oversupply or respond particularly well to pumps. The best way to get more milk out is to pump more often. What do you do for a living? Do you have your own office? Could you possible get a nursing cover and pump in your office more often?

Does your care provider wait for hunger signs to feed baby.. and offer the least amount and then wait and see if that's enough? Is it possible to use smaller bottles of breast milk or offer less? She may reverse cycle a bit for you, thus nurse a bit more when with you, if they wait to cue feed vs. schedule her. I suppose it depends on who is caring for her whether they'd be willing to do that or not. And it also depends on if you're willing to lose a little sleep in order to nurse slightly more when together. ;)

Just because you stop pumping at a year, doesn't mean your LO would have to stop nursing when with you. Care providers can give a bit more on the solids end.. and if necessary you can switch to goat/almond/coconut milk whatever if necessary.. and then just nurse when with your LO. Past a year as long as she nurses 3-4 times per day/night/morning whatever in a 24 hour period, you don't have to give any replacement for the breast milk (ie: cows/almond/coconut whatnot milk will not be necessary).. just give water and good nutritious solids apart from you - maybe a wee bit of coconut milk or juice when apart. As she gets older, reverse cycling, if you are okay with it, will become more and more possible to achieve as she becomes more efficient at nursing and nurses less in general. Your breast milk will change to reflect the decreased nursing sessions, increasing in fat, therefore calories, and antibodies as she nurses less often.

It really isn't necessary to keep leaving her with so much expressed milk after a year. :) So if you don't want to end your breastfeeding relationship at that point, you don't have to end it! You could pump once or twice at work on normal break/lunch in order for a supply boost and to relieve engorgement if that is a problem. But your supply will change to meet demand and high milk supply time will alter to fit when baby nurses more.

As far as increasing your supply - I'm curious if you really need to or not. I'd like to know how much expressed milk she's being given whilst apart from you.. If it really is not enough - and smaller bottles do not cut it for her (evidenced by feeding the smaller bottle and baby still protesting 10 minutes afterward.. or becoming of course hysterical or something) - giving a little formula supplementation isn't the end of the world. Maintaining a nursing relationship does NOT have to be all or nothing, at all! Think of it like starting solids. Many children continue to nurse well into their 3rd to 6th year if allowed ;) Do you think they eat only breast milk? Nooo.. Solids are in the mix very much so, some children only nurse every few days or even every couple weeks at that point.. but it still VERY beneficial to them, especially if they become ill! ;) Nursing does not have to be all or nothing! Yes, in the first 6 weeks or so exclusive breast milk diet is rather important. And it's more ideal for health to have the first 6 months have only exclusive breast milk diet. But if it isn't possible -- providing breast milk in any amount trumps NOT providing it. And after 6 months, you don't need to worry as much about the open gut and such anyway. So a little formula in the mix.. nay.. try not worry so about it but keep in mind breast milk isn't like formula.. You don't have to increase how much you give as times goes on, (besides during the growth spurts) because breast milk changes itself to fit the babies needs. It becomes more nutrient and calorie dense all on its own as babies nurse a little less often. I definitely think ya should go to kellymom and check it out ;)

If you DO need to increase your supply a bit.. Have you tried mother's milk tea, fenugreek, garlic, eating a good portion of red meat, brewer's yeast, or pumping whilst watching a video or looking at a photo of your child.. along with breast compressions??

I understand losing a little money or time at work. But, honestly, I believe providing at least mostly breast milk to a child is a health issue not worth compromising. It is just far healthier for them than solely formula or other milks. I believe if you keep expressing milk at work til the 1st year and then nurse when with her past that, you will look back at how much your daughter thrived on it and it made her healthier and easier to deal with etc. and never regret losing a tiny bit of money in the scheme of this long life we generally live. Is there anywhere else you could cut back financially that would eliminate the need to worry so about your unpaid breaks?

If these people are discriminating against you because you are breastfeeding mother who take 10-15 minutes to express milk every 2-3 hours -- I do not believe that is legally appropriate! If you had ANY OTHER medical condition that required you to say -- frequent the bathroom a little more often but you conceded to having unpaid time to do so -- they would not discriminate so! ! They are the ones who need their minds adjusted to reality.. Not you hun. They need a wake-up call that our country doesn't appreciate its working mothers like they should -- it benefits them to!!.. and when they do appreciate them they actually make more money! Breastfed children are ill less (well past when they are breastfeeding), which means moms have to take time away less, and mothers providing breast milk are less likely to become depressed and generally work harder after their break is over to make up for being away for a little while. Keeping moms and babies happy and healthy SAVES them money in the long run, so they should really appreciate it more than they do and be in AWE not be impatient and angry about it.

I understand family nagging. I just remind my family that my son has NEVER been sick and explain about the benefits for the 10th time (reduced risks of diabetes, cancer, illness, etc. for him.. reduced risk of breast cancer, PPD, and osteoporosis for me!) They surely shush.

And.. I just wanted to say. . how wonderful that you have provided breast milk whilst working! It surely is a bit of a hassle for you, I am sure! Congratulations and job well done on doing so, no matter what you decide to do at this point - you have done your baby a world of good already! :)

August 3, 2010 | Unregistered CommenterFogedaboudid

I am thinking about "big baby inductions". Specifically, OBs often tell expectant mothers that babies gain 1/2 lb per week in the last few weeks of pregnancy, so if a baby seems big at 38 weeks, they had better not wait long to deliver. I even saw the 1/2 lb. figure on an ACOG poster in the OB's office last week (not that this particular OB is giving me a "big baby" talk). Where are the data to back that 1/2 lb. up?

I found a few online charts, and they showed that weight gain really tapered off near the due date, and especially after it. I have always delivered near 41 weeks and never had huge babies. I also found a research paper detailing only about a 90 gram (3 ounce) average weight gain per week from 38-42 weeks.

"... the normal range of term birth weight is typically referenced to the mean birth weight for pregnancies delivered at 38-42 weeks' gestation (ie, mean term gestational age ± 2 SDs). During this 4-week interval, the typical fetus gains approximately 12.7 ± 1.4 g/day, with a difference of ± 0.3 g/day depending on the sex of the fetus (male fetuses gain weight more rapidly than female fetuses.)"

http://emedicine.medscape.com/article/262865-overview

Other charts:

http://www.ob-ultrasound.net/weight.html

http://www.babycenter.com/average-fetal-length-weight-chart

August 3, 2010 | Unregistered CommenterKK
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